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1. Infection Control in Health Care Settings Osama R amadan

2. Florence Nightingale, Notes on Hospitals, 1863 It may seem a strange principle to state the very first requirement of a hospital that it do the sick no harm

3. What we do?

4. Learning Objectives Recognize patient safety as an important nursing responsibility in global health care systems. Apply required knowledge in preventing and/or minimizing infection. Perform appropriate behaviors required to prevent health care associated infections. Demonstrate required competence to provide patients with safe care.

5. Objectives cont’d Discuss basic infection control (IC) concepts State the causes of nosocomial infections list the components of an infection control program Understand how the Infection Control Committee and DTC can decrease the incidence of nosocomial infections and antimicrobial resistance (AMR)

6. Key Definitions (1) Infection Control — The process by which health care facilities develop and implement specific policies and procedures to prevent the spread of infections among health care staff and patients Nosocomial Infection — An infection contracted by a patient or staff member while in a hospital or health care facility (and not present or incubating on admission)

7. Key Definitions (2) Disinfection — The process of microbial inactivation that eliminates virtually all recognized pathogenic microorganisms, but not necessarily all microbial forms (e.g., spores) Sterilization — The use of physical or chemical procedures to destroy all microbial life, including large numbers of highly resistant bacterial endospores. Procedures include — S team sterilization Heat sterilization Chemical sterilization

8. How are infections transmitted?

9. Global Infection Problems According to WHO (2005), On average, 8.7% of hospital patients suffer health care-associated infections (HAI). In developed countries: 5-10% In developing countries: Risk of HAI: 2-20 times higher HAI may affect more than 25% of patients At any one time, over 1.4 million people worldwide suffer from infections acquired while in hospital.

10. Health Care-Associated Infections (HAI) According to WHO: HAI is also called “ nosocomial ”. HAI is defined as: an infection acquired in hospital by a patient who was admitted for a reason other than that infection. an infection occurring in a patient in a hospital or other health-care facility in whom the infection was not present or incubating at the time of admission.

11. Impacts of Health Care-Associated Infections (HAI) HAI can: Increase patients’ suffering. Lead to permanent disability. Lead to death. Prolong hospital stay. Increase need for a higher level of care. Increase the costs to patients and hospitals.

12. Root Causes of Nosocomial Infections (1) Lack of training in basic IC Lack of an IC infrastructure and poor IC practices (procedures) Inadequate facilities and techniques for hand hygiene Lack of isolation precautions and procedures

13. Root Causes of Nosocomial Infections (2) Use of advanced and complex treatments without adequate training and supporting infrastructure, including — Invasive devices and procedures Complex surgical procedures Interventional obstetric practices Intravenous catheters, fluids, and medications Urinary catheters Mechanical ventilators Inadequate sterilization and disinfection practices and inadequate cleaning of hospital

14. What is Infection Cycle Patient to Worker Visitor Patient Worker to Worker Visitor Patient Visitor to Worker Visitor Patient

15. Preventing infections Requires health care providers who have: Knowledge of common infections and their vectors An attitude of cooperation and commitment Skills necessary to provide safe care

16. Required Skills Apply universal precautions* Use personal protection methods Know what to do if exposed Encourage others to use universal precautions Report breaks in technique that increase patient risks Observe patients for signs and symptoms of infection

17. One more important thing! Protect Yourself Be sure you have been immunized against Hepatitis B since it is very easy to transmit!

18. Main Sources of Infection Person to person via hands of health-care providers, patients, and visitors Personal clothing and equipment (e.g. Stethoscopes, flashlights etc.) Environmental contamination Airborne transmission Hospital staff who are carriers Rare common-source outbreaks

19. Main Routes for infections Urinary tract infections (UTI) Catheter-associated UTIs are the most frequent, accounting for about 35% of all HAI. Surgical infections: about 20% of all HAI Bloodstream infections associated with the use of an intravascular device: about 15% of all HAI Pneumonia associated with ventilators: about15% of HAI

20. Burke J Infection control-a problem for patient safety New Eng Journal of Medicine (February 13, 2003) Types of Infections

21. Four Ways to Prevent HAI Maintain cleanliness of the hospital. Personal attention to hand washing before and after every contact with a patient or object. Use personal protective equipment whenever indicated. Use and dispose of sharps safely.

22. The single most effective way to reduce spread is ...

23. Your 5 moments for HAND HYGIENE

24. Respiratory Hygiene Cough & Sneeze Etiquette Covering mouth and nose when sneezing or coughing Use tissues, use once and dispose into a rubbish bin Perform hand hygiene

25. Personal Protective Equipment Gloves, aprons, gowns, eye protection, and face masks Health care workers should wear a face mask, eye protection and a gown if there is the potential for blood or other bodily fluids to splash.

26. Personal protective equipment 2 Masks should be worn if an airborne infection is suspected or confirmed to protect an immune compromised patient.

27. Gloves Gloves must be worn for: all invasive procedures contact with sterile sites contact with non-intact skin or mucous membranes all activities assessed as having a risk of exposure to blood, bodily fluids, secretions and excretions, and handling sharps or contaminated instruments. Hands should be washed before and after gloving

28. Safe Use and Disposal of Sharps Keep handling to a minimum Do not recap needles; bend or break after use Discard each needle into a sharps container at the point of use Do not overload a bin if it is full Do not leave a sharp bin in the reach of children

29. Aseptic Technique Practice of ensuring that bacteria are excluded from open sites during surgery, wound dressing, blood sampling, and other medical procedures. Aseptic technique is a first line of defense against infection. Use of sterile instruments and supplies and the application of principles of asepsis while performing invasive procedures are important aspects of infection control.

30. Examples of aseptic technique include: - Disinfecting IV ports/valves and capping open lines - Checking the integrity of sterile packages and ensuring a color change on the chemical indicator - Use of a sheathed catheter for closed suctioning of ventilated patients.

31. Isolation and Precautions - More Safety Activities Along with good hand hygiene, Standard Precautions and disease specific precautions help prevent the transmission of organisms. There are 6 types of precautions used at Karmanos : 1. Standard Precautions 2. Contact Precautions 3. Contact Precautions with Special Cleaning 4. Droplet Precautions 5. Airborne Precautions

32. Standard Precautions Standard Precautions – is used with all patients and assumes that all patients are infectious. Protective barriers called Personal Protective Equipment (PPE) includes gloves, goggles/eye shields, masks and gowns are used to prevent contact with patients’ blood or body fluids. The type of activity or task determines the amount and type of PPE to be used. The greater the risk of coming in contact or being splashed with the patients’ blood or body fluids, the more protection is needed.

33. Masks, eyewear and face shields protect your eyes, nose and mouth. from splashes or splatters of blood and body fluids Make sure to choose PPE that will protect your eyes, nose and mouth if there is any chance of splash. Examples of tasks when you should wear such PPE include: Suctioning Irrigating wounds Cleaning contaminated equipment Place disposable PPE into general waste container after use. Standard Precautions Personal Protective Equipment (PPE) -Masks

34. Standard Precautions Personal Protective Equipment (PPE) - Gloves Gloves keep potentially infectious materials away from your hands during contact with patient’s blood, body fluids, mucous membranes, or broken skin. Gloves also protect you from contact with infectious materials when handling contaminated equipment, surfaces, linen or waste. Remove gloves immediately after the task is done. Dispose gloves into a general waste container. Perform hand hygiene after removing and disposing gloves. NEVER wash gloved hands. NEVER reuse disposable gloves. Change gloves after each procedure; even if performing more than one procedure on the same patient. Standard exam gloves are latex-free.

35. Standard Precautions Personal Protective Equipment (PPE) – Gowns Fluid-resistant gowns prevent blood and body fluids that splash or spray from soaking through to your clothes and skin. Dispose gowns after use in general waste container, NOT medical waste biohazard container. Some situations that may require wearing a gown include: Irrigating a wound Performing tracheostomy care Any time blood or body fluid contamination to your clothes skin is likely

36. Airborne Precautions Place patients in Airborne Precautions if they have a disease that is transmitted by the airborne route (except Tuberculosis). These diseases include: Chicken Pox/Varicella Measles Disseminated Herpes Zoster (Shingles)

37. Contact Precautions Required to prevent transmission of infectious agents such as Multi-drug resistant organisms (i.e. Acinetobacter , Pseudomonas, KPC), and Rotavirus, which are spread by direct or indirect contact with the patient or the patient’s environment. Gown and gloves upon entry to room. Discard PPE before exiting room. Change gown and gloves after preparing patient for transfer out of room and perform hand hygiene. Don new PPE to assist with patient transfer outside of room.

38. Contact Precautions with Special Cleaning This is signage for our patients that have C.difficile disease. Contact Precautions are followed PLUS the signage is on the door to remind our Environmental Services staff to use a bleach detergent when cleaning the surfaces in the room .

39. Droplet Precautions Used in the care of patients with suspected or confirmed infections such as Pertussis, Influenza, Rhinovirus, Neisseria meningitidis and RSV which are transmitted primarily by droplet route. Surgical mask is required upon entry to room

40. Bloodborne Pathogen Standard Hospitals are required by the Bloodborne Pathogen Standard of MI/OSHA to protect all healthcare workers (HCWs) from exposure to bloodborne pathogens, while on the job. Assume that all patients could have organisms that are transmitted by contact with their blood and/or body fluids. Follow Standard Precautions. The MIOSHA Blood Borne Pathogen Exposure Control Plan is the policy that describes protection measures for staff and patients. Refer to policy IC 110

41. Bloodborne Pathogen Standard Epidemiology of Bloodborne Pathogens: Important bloodborne pathogens (disease-causing organisms) that may be present in human blood could include: Hepatitis B Virus (HBV) Hepatitis C Virus (HCV) Human Immunodeficiency Virus (HIV) These same bloodborne pathogens may also be found in other body fluids, including: Semen Vaginal fluids Fluids around the brain, spine, heart, lungs, abdomen and joints Bloody saliva during certain dental procedures Bloodborne pathogens are NOT found in tears, urine, stool, sweat or saliva unless these body fluids are visibly bloody.

42. Bloodborne Pathogen Standard Exposure to Bloodborne Pathogens: HCWs may be exposed to bloodborne pathogens by: Your skin being punctured with a contaminated needle or cut by a contaminated sharp device, such as a lancet or scalpel. Blood or body fluids getting on skin that has cuts, cracks, rashes or burns. Being splashed or sprayed with blood or body fluids into your eyes, nose or mouth. Certain HCWs have a higher risk of exposure to bloodborne pathogens while on the job. Nurses and Patient Care Staff Physicians Lab Staff Environmental Services Staff who handle Regulated Medical Waste Dental Staff

43. Bloodborne Pathogen Standard Symptoms of Blood Borne Diseases Symptoms of Hepatitis B, C and HIV may include: Fever Fatigue Flu-like illness Nausea Vomiting Diarrhea Loss of Appetite Weight loss Jaundice Itchy skin Night Sweats Swollen Lymph Glands Pneumonia

44. Bloodborne Pathogen Standard Standard Precautions requires HCWs to treat all blood and body fluids as if they are infected with disease- causing organisms. ALWAYS using Standard Precautions will prevent the spread of disease to yourself, co-workers, patients and visitors. Your protection and Safety is important. Know where to find PPE in your department.

45. How to Manage a Blood or Body Fluid Spill Small spills that can be contained by a paper towel will be cleaned and disinfected by the department. The Small Spill Procedure is: Put on PPE Contain and absorb spill with paper towels Dispose of the paper towels Add approved disinfectant to the spill site Dispose of used supplies in general waste container Remove gloves and perform hand hygiene Large spills will be contained by the department with a barrier pad and then disinfected by Environmental Services. See Blood and Body Fluid Spill policy IC 134 on the KCC Policy Web Site.

46. Bloodborne Pathogen Standard Safe Sharps Disposal Locate sharps container close to point of use. After use, immediately activate safety feature, if appropriate, then dispose sharp into an approved puncture-resistant container. NEVER leave sharps for someone else to clean up. Observe container opening. If sharps are protruding, do not put your hands near it. NEVER overfill sharps containers. Replace sharps containers when they are ¾ full. Lock sharps containers before moving or replacing them.

47. Bloodborne Pathogen Standard Safety Devices Needleless IV system Safety butterfly phlebotomy device Safety lancets Safety blood gas syringe Safety IV catheter Safety syringe and needle Safety huber needle Blood transfer safety device Hemodialysis safety fistulas Safety scalpels utilized outside the operating room Safety devices available for staff to use: Evaluations and implementation of safer devices is an ongoing KCC commitment. REMEMBER: Safety devices will protect you only if you activate the safety feature after use.

48. Regulated Medical Waste is waste that may contain disease-causing organisms. Michigan law requires health care waste to be segregated properly. Please do not use these red containers for your regular trash. Regulated Medical Waste must be placed into closeable, leak-proof containers that are lined with a red bag and labeled with the biohazard symbol. Waste disposal

49. Bloodborne Pathogen Standard What is Regulated Medical Waste? Tissue and other pathology lab waste Lab specimens (not urine) Bulk blood and body fluids Blood and blood-product bags Dressings soaked with blood PPE soaked with blood Urinary catheters and collection bags Empty drainage containers such as suction canisters Dressings stained with blood PPE stained with blood Diapers Sanitary napkins Regulated Medical Waste : Throw these away in the Red Biohazard container General Waste: Throw these away in the regular trash

50. Required Performance Nursing students need to: a pply universal precautions b e immunized against Hepatitis B u se personal protection methods k now what to do if exposed e ncourage others to use universal precautions

51. Infection Control Committee Membership— Doctors General physician Infectious disease specialist Surgeon Clinical microbiologist Infection control nurse Representatives from other relevant departments Laboratory Housekeeping Pharmacy and central supply Administration

52. Thank you